Author: Margaret Ogbonnah

Introduction:

In Insurance, a claim is a request made to an insurance company by an insured individual or corporate entity for payment or compensation of a loss or damage covered by the insurance policy. The claim is made following the occurrence of a covered incident. The payment received by the insured individual will compensate for financial damages incurred as a result of the occurrence.

Simply put, a claim on an insurance policy is a formal notification to the insurance company that a loss or damage is covered by an insurance policy. The insurer will review the claim and see if the events or circumstances are risks covered by the policy. If the claim is approved, the benefit or payout refers to the replacement or repair of any property or any money made by the insurer who will then assess the claim’s value and offer the appropriate benefit as provided in the insurance contract.

There are several types of insurance claims, including property damage claims, liability claims, personal injury claims, and disability claims, amongst others. Insurance may offer financial security, risk management, legal compliance, business continuity, and investment possibilities to individuals and corporations. This article explains the steps involved in making insurance claims in Nigeria.

Conceptual Clarification:

Insurance is a contract, represented by a policy, in which a policy holder receives financial protection or reimbursement against losses from an insurance company. Insurance policies hedge against financial losses resulting from accidents, injury, or property damage. Insurance also helps cover costs associated with liability (legal responsibility) for damage or injury caused to a third party.

Moreso, insurance contracts generally may be oral or written or implied by the conducts of the parties in line with the customs or usage of a trade or profession. However, certain contracts are governed by statute and insurance contracts fall under such category. Section 50 of the Insurance Act governs insurance contract in Nigeria. The provision provides that payment of an insurance premium is a condition precedent to the establishment of an insurance contract.

The natural consequence of this is that when an insurance premium is not paid, there cannot be an insurance contract. The provision further stipulates that “there shall be no cover in respect of an insurance risk unless the premium is paid in advance.” This means that payment of insurance premium is not the only condition precedent to the establishment of an insurance contract; the premium must also be paid in advance.

Part payment of insurance premium cannot constitute a valid and enforceable insurance contract. The reason for this is that the Insurance Act does not
contemplate part payment of insurance premium. What the Insurance Act states is that there must be payment of premium in full and the payment of such premium must be in advance.

The consequence of non-payment or part payment of insurance premium is that there is no valid insurance contract and same cannot be enforced by a Court of law. For there to be a valid and enforceable insurance contract, there must be –
(a) payment of insurance premium which must be full
(b) the payment of the insurance premium must be in advance
(c) there cannot be part payment of insurance premium.

Consequently, once there is non-payment of insurance premium or part payment of insurance premium, in the eyes of the law, there is no insurance contract or at best, the said contract is an illegal contract incapable of being enforced in law. It is therefore advisable that in entering an insurance contract in Nigeria, the premium must be paid in full and in advance as at the time of entering into the insurance contract.

How To Make An Insurance Claim In Nigeria.

The process of making an insurance claim in Nigeria may vary slightly depending on the type of insurance policy you have and the specific procedures of your insurance company. Different companies have different processes through which customers can file their claims, however, the steps provided in this article have been written to suit whatever insurance claim you are filing.

Insurance policies have specific terms and conditions that outline what is covered and what is excluded from coverage. It is essential to read and understand these terms and conditions before making a claim.

The steps to make a valid claim are as follows:

Determine your losses

Identifying your losses before informing your insurer is the first step to properly submitting an insurance claim. This can assist you in comprehending the kind and scope of your loss so that you can provide your insurer with accurate information when submitting an insurance claim. Furthermore, determining your losses will allow you to independently assess your losses in light of your insurance policy. That way, you save yourself the stress of filing for losses not contained in your policy.

Notify the insurance company.

Depending on your insurer, you may be required to file a claim within a specific time frame in order to get reimbursement. Some insurance companies may also require the complainant to fill out a Claim Form.

It is strongly advised that you file your claim as soon as possible. Information will also be required to demonstrate the existence of any damage or injuries. You could be required to offer evidence on the circumstances surrounding the event, its setting, the people involved, and (if appropriate) the names and contact information of any witnesses. This is considered as officially registering your losses, and you must ensure that you follow the procedures outlined in your insurance policy.

To complete the claim, certain insurance companies might need some supporting paperwork. Such required documents are often made available on their websites for the use of their customers. These documents may include a police report, medical report, receipts and any other relevant evidence that supports the claim.

Assessment of Insurance Coverage

Following the receipt of the insured’s claim, the insurance company must now assess the authenticity of your claim. This is frequently handled by a claims
specialist from an insurance company. Before payment may be made, the insurance company must approve the claim. They will also check the validity of the insured’s policy or coverage.

The time it takes to process a claim is determined by the intricacy of the case and the insurance company’s efficiency.

It is important to note that the fact that the insured has experienced a loss and filed a claim for compensation does not determine that the insured will receive compensation. The insurance company must undertake an investigation to determine the cause of the loss and compute the overall losses. The loss adjuster from the insurance company will mostly conduct this assessment. The loss adjuster is often tasked with preserving the insurance company’s interests and ensuring compliance.

Payment and claim approval

A Claim is either approved or denied by the insurance company, once the insurance company gives approval for payment, the claims proceed to the stage when the insurer makes an offer to the insured and subsequently settles with them.

Payments may be issued to the insured, another individual entitled to the insurance policy, or a third-party organization. However, if the Claimant fails to substantiate his loss sufficiently, the Insurer may reject the obligation. If a claim is denied, the policyholder has the option to appeal the decision. The insurance company will typically provide instructions on how to appeal the decision.

CONCLUSION

In conclusion, to ensure a hassle-free insurance claim process, it is advisable to thoroughly review your insurance policy and diligently follow the instructions provided by the insurance company. By adhering to these guidelines, you can increase the chances of a successful claim and ensure a seamless experience.

Furthermore, a careful approach and adherence to the recommended steps can make all the difference in the insurance claim process.

REFERENCES
1. Section 50 of the Nigerian Insurance Act 2003.
2. Nigerian Insurers Association – The Insurance Act (nigeriainsurers.org)
3. Insurance Act 2003 | LawPàdí (lawpadi.com)
4. Making A Valid Insurance Claim In Nigeria – TheNigeriaLawyer
5. Legality And Enforceability Of Insurance Contract In Nigeria – Insurance Laws and Products – Nigeria (mondaq.com)
6. How To Make An Insurance Claim In Nigeria – Insurance Laws and Products – Nigeria (mondaq.com)

DISCLAIMER; This article is for information purpose, it may, or may not reflect the current position of the law and is therefore not intended to provide legal advice or guidance on litigation or provide commentary on any pending case or legislation.